This Program Project proposal represents a continuation of our existing Program Project (PO1 HL47540), which is now entering its 10th year. Supported by NHLBI since 1985, it comprises a body of work that focuses on the role of psychosocial factors in the development of hypertension and cardiovascular disease, led by a well-established, multidisciplinary group of investigators at Mount Sinai School of Medicine and neighboring institutions. The proposed projects are an outgrowth of our previous and current work, and focus on a set of inter-related themes concerning the causes and consequences of sustained blood pressure elevation. Project 1 (International Follow-Up of Ambulatory BP and CV Events) extends our focus on the utility of ambulatory blood pressure monitoring in clinical and research applications. The goal is to complete the data collection for a comprehensive data base of ambulatory blood pressures and follow-up cardiovascular events in patients seen in our clinic over the past 23 years. These data will be pooled with similar prospective data bases from laboratories from other countries, providing substantial power to study the dose-response relationship between ambulatory blood pressure and cardiovascular events and investigate similarities/differences across cultures. Project 2 (Masked Hypertension - Risk Factors and Consequences) focuses on the difference between ambulatory and clinic blood pressures and those persons who exhibit normal clinic blood pressure but hypertensive blood pressure during ambulatory monitoring in the natural environment. These persons (estimated at 10%-20% of the population) represent an important model for the study of human hypertension, as these persons may be at elevated risk for end organ damage (due to their elevated ambulatory blood pressure and are unlikely to be treated. This study will investigate the reproducibility of the ABP/clinic BP difference, the psychosocial factors that are associated with this difference, and whether this difference is associated with left ventricular structure and function. Project 3 (Effects of Angry Perseverative Cognition on Ambulatory BP) is an extension of our research examining the cognitive and psychological underpinnings of prolonged blood pressure elevation. This study will utilize a field manipulation of angry cognition, and examine the effects on blood pressure recovery in the laboratory and in the field.